Book reviews

Kenneth Warren's latest book takes its place amidst an impressive body of scholarship concerning the American steel industry. A professor at Oxford, Warren's books include Big Steel: The First Century of the United States Steel Corporation 1901-2001; The American Steel Industry, 1850-1970: A Geographical Interpretation; and Wealth, Waste and Alienation: Growth and Decline in the Connellsville Coke Industry. Already having written the best business biography of Henry Clay Frick, Triumphant Capitalism: Henry Clay Frick and the Industrial Transformation of America, he has now produced a biography that represents a significant advance over Robert Hessen's Steel Titan: The Life of Charles M. Schwab published in 1975. Warren tells the story of Charles Schwab who became president of Carnegie Steel at 35 years of age, the first president of U. S. Steel four years later, and then president of Bethlehem Steel, which he built into America's second largest steel producer. Warren's book on Schwab, while recognizing his managerial talent and energy, provides a more balanced appraisal of the negative impacts of the tough labor policies of the great steel men than does Schwab's previous biographer. Hessen, as befits an admirer of the ultra-conservative novelist/philosopher Ayn Rand, focused more on the personal flaws that limited the dominance of the great man, rather than the consequences for workers and their communities of the aggressive and acquisitive drive of industrial capitalism. To his credit, Warren poses the question: "Was confrontation or even the grinding down of workers the only way of dealing with labor?" Like many men who arrived in Pittsburgh during the extraordinarily expansive economic growth that followed the Civil War, Schwab was in the right place at the right time. Broad-based technological breakthroughs, the rapid exploitation of a nearly virgin natural world, and an expanding availability of labor power provided by immigration and improved public health created conditions that made possible a veritable explosion of material production and wealth accumulation never before seen in human history. Pittsburgh was at the epicenter of this eruption of production for 50 years and men like Schwab, Frick, Carnegie, and Andrew Mellon rode the wave and came to see themselves as the titans, moguls, and barons of the new world order. Schwab caught the wave and artfully maneuvered his way to the top of the industrial heap, combining a solid steel operations background-learned from the redoubtable Captain Bill Jones in Braddock-with a talent for salesmanship that was capable of charming workers, bankers, and politicians. A small town boy from the intensely Catholic central Pennsylvania town of Loretto, Schwab had a sharply competitive nature and an enormous capacity for work. Becoming the superintendent of the Homestead Works in 1886 at the age of 24, he developed an expertise in the production of armor plate, introducing basic (as opposed to acidic) open hearth steel production to the United States. Upon the death of his mentor Bill Jones in a furnace accident in 1889, he took over the reins of the Braddock mill, only to return to Homestead following the 1892 strike. At both plants he used his personality and constant presence to control the workforce, while squeezing pay scales and dealing firmly with labor disputes. Schwab played several important roles in American industrial history. As president of Carnegie Steel, he used his close relationship with Andrew Carnegie and his diplomatic skills to negotiate the creation of U. S. Steel. The emergence of the world's first billion dollar corporation forestalled an industrial war between Carnegie and his rivals including his bitter enemy, Henry Clay Frick, who was backed by Andrew Mellon. Ironically, Schwab's triumph and accession to the presidency of the nation's biggest corporation led to his own undoing. As the chairman of the board of the new behemoth, Judge Elbert Gary, and its financier J.P. Morgan, sought industrial stability and financial predictability rather than the wheeling and dealing competition practiced by Carnegie's "boys." Schwab's other major contribution came as president of Bethlehem Steel where his knowledge of armor plate and shipbuilding made him an important contributor to

?17(3 Mr. Parkinson, on the Nature and Cure of Gout> parts which it affects^ a concrete saline substance, which is some'* times accumulated in considerable quantities, particularly on the joints of the fingers and hands. " The different forms in which this disease appears, have rendered it necessary to divide it into regular and irregular gout. In the former, the attacks of which are known by the denomination of regular fits of the gout, one or more joints of the extremities become inflamed, painful, and tender, and frequently in an exquisite degree; A symptomatic fever, proportioned to the degree of pain and inflammation, with evening exacerbations, accompany the other complaints,-which distress the patient for uncertain periods, sometimes for several weeks. When the fit goes off, the joints, which have been the seat of the disease, are always found to have become rigid and inflexible, in proportion to the degree in which, the disease has existed in them; frequently remaining enlarged, and incapable of free motion, for a considerable time. On the other hand, the patient, at the same time, experiences so perfect an exemption from disease, as generally to lead to the opinion, that the lit has occassioned the most salutary changes in the system. " In the irregular gout, the affection of the joints is much les9 confined than in the former. Sometimes it leaves the joints at first attacked, and fixes on some distant part; and sometimes, after harrassing the patient, by making a circuit including almost every joint of the extremities, the fit is terminated by a renewed attack on the part first affected. In some cases, the disease quits its situation in the extremities for a time, and occasions symptoms of a very alarming nature, by its attack on some internal part; this also' abating on the return of the disease to the part which had been first attacked : this is termed, retrocedent gout. In other cAses, in which there exist the most evident marks of a gouty diathesis, no affection of the extremities takes places, but complaints of a very anomalous kind shew that some internal part is under the influence of this disease: these may be regarded as cases of misplaced gout. A want of power and tone in the system appears L) accompany both these states of gout. " The proximate cause of gout appears to be?a peculiar saline acrimony existing in the blood, in such a proportion, as to irritate and excite to morbid action, the minute terminations of the arteries, in certain parts of the body." In pursuing this inquiry, inductions are formed from the acidity ftyolved from the stomach from the acescent drinks taken by the wealthy, who arc the principal subjects of gout, from the superabundance of phosphate of lime, and, probably, other extraneneous matters in the urine of older people after the process of ossification has been completed ; and from the great quantity of fluid, which Dr. Woollaston found necessary for the solution of gouty calculij which proves its constant disposition tQ precipitate.
In the next Chapter, the author enters on the remote causes.
The principal of these are, hereditary disposition; indigestion ; errors in non-naturals; intemperance; different effect from different fermented liquors; circumstances preventing the escape of morbid acid. On this we would wish to remark, that when hereditary disposition is considered as a remote cause, it ought not to be confounded with those afterward enumerated, which are altogether accidcntal, or such as may be prevented. We should rather consider hereditary predisposition (a term we think preferable to a word often applied to other conditions of the body) as an original organization, rendering the constitution, or certain parts, susceptible of the impression from the remote causes. It is well known, that these same causes produce different effects, according to the original organization, and that such organization depends on causes, we can neither trace nor controul, nor even know, but by the effects of the remote causes.
Among these causes, I\Ir. P. considers wine, and still more, cyder, as the most considerable. Beer, he conceives innocent, till it has been kept long enough to acquire a degree of acidity. A long quotation follows from Dr. Cadogan, which, we suspect, our author would not be ready to adopt as his own; for, it fcrmenting liquors of any kind, and bread, are so dangerously acescent, it is difficult to conceive, why women, and such of the labouring class whose occupations are sedentary, are not universally gouty, as they are not less subject to all the circumstances which prevent the escape of the morbid acid than the wealthiest arthritic.
The third Chapter contains an examination of the symptoms and their agreement with the supposed proximate cause. In this the author enumerates most of the symptoms, and shows, that they may for the most part, be attributed to the evolution ot acidity, and of its retention from the cessation or diminution of any customary discharge. In this chapter, much is insisted upon from, the frequent occurrence of gout anil urinary calculi in the same constitutions. This appears to us an error originating with Sydenham, and adopted from him by every succeeding writer. If it is not an error, it is, at least, not supported by a sufficient number of facts to be considered, as it usually is, among those data on which presumptive reasoning may be supported.
In the fourth Chapter are contained : the diagnosis ; difference between gout and rheumatism ; anomalous complaints apparently dependant on gout. AVe are not satisfied with all the inferences our author would draw from the facts he produces in this part of his reasoning. It is well known, that inflammation (if any kind will shift from one part to another, and also that diseases will succeed each other in the same constitution : that these inflammations will produce effects according to the parts' affected ; and the diseases, whilst one supercedes the other, seem-totally unconnected with each other, not only in their symptoms, but in Uieii' supposed remote causes. The fifth Chapter contains some very useful practical remarks on particular affections of the joints, apparently dependant oil the same state of the system as that which produces gout. Dr.
Haygarth has given a very accurate description of this disease,, nor has it been overlooked by the accurate Heberden.
As there are some differences in the descriptions of these Gentlemen, and also in their opinions, as to the gouty origin of the complaint, it is much to be regretted, that Mr. Parkinson did not; make use of a chemical test to ascertain the component principles of those enlargements which form the character of the disease in question. As the description here offered is very minute, we shall transcribe it, that our readers may compare it with those of Drs.

Ilaygarth and Heberden.
" It generally first manifests itself in one of the last joints of the fingers; the ends of the bones forming the joint become slightly painful and tender, and a small degree of enlargement i* at first perceived. The swelling,, with the tenderness and pain, gradually increase ; so that, at different periods, in different persons, but generally in about three months, the pain and enlargement occasion considerable inconvenience. Myriads of minute hot points sometimes seem to be piercing the bone, whilst at other times a stinging sensation pervades the tumefied part; the pain being considerably increased by the least pressure. The motion of the joint becomes so impeded by the enlargement, that the merely closing of the hand, in its ordinary employments, produces a very considerable degree of pain. " As the swelling continues to enlarge, a very slight degree of redness comes on, and sometimes threatens suppuration, which, however, very seldom ensues. Sometimes this inflammatory state, after continuing a certain time, varying much in this respect in different persons, at length subsides, when the mobility of the joint is found to be much diminished, and the swelling increased in siz? and hardness, but much less painful and tender. In this state it sometimes continues, with the exception of a very gradual increase of the size and hardness of the tumour, and consequent injury to the motion of the joint, during the remainder of life. " Within a little time, perhaps two or three months, of the appearance of this first swelling, some of the first joints of the other fingers become affected in a similar manner, and pass through a similar course: and thus most of the other finger joints become the seat ot this malady, and undergo the morbid changes just described.
" As the mischief advances in the hand, proofs of the general influence of a peculiar morbid state are evinced, in some of the larger joints, particularly in the wrists, the elbow, the ankle, and knee joints. But even when the larger joints are attacked, it is not to be ascertained, in the living subject, whether the seat of this malady is in the more prominent parts of the ends of the tones, which form the joint, or of the periosteum, just before it it separates to give a covering to the capsular ligament, or in the ligamentous parts alone. Sometimes extreme tenderness, on pressure being applied, shews that the os calcis, or its immediate investiture, partakes of the mischief. This tenderness, which, in the first of the morning, will hardly allow the foot to rest on the ground, diminishes after the pressure has been repeated, during walking, for about half an hour. Sometimes the tenderness, accompanied by a slight degree of enlargement, exists at the back part of the os calcis ; and in one case a knotty seam-like hardness was discoverable in the tendo achillis, which very much impeded the walking. A hardness somewhat similar, with an indentation and contraction affecting even the integuments, is also sometimes observed in some of the flexor tendons of the fingers, in those who possess the diathesis here described. When this is the case, the corresponding finger will always be found firmly contracted, in proportion to the injury which the flexoi tendon has experienced. " Frequently the bones of the feet become so affectcd. as to occasion great difficulty and pain in walking, which is only performed, in a manner, which renders the crippled state ot the parts very evident; giving the idea to the patient ot the ir.eta* tarsal bones, which form the arch of the foot, being crushed together by the pressure of the body. " After some time, most of the joints, and, with the rest, those of the spine, partake of the prevailing disposition to rigidity; so that at last the flexibility necessary for performing the most simple offices' in life is lost. Thus crippled, the unhappy sufferer sinks junder his calamity ; his various incapacities, proceeding from his inability for motion, giving the idea of his being prematurely afflicted with the decrepitude of old age. enlarged upon with the hope of exciting the attention of medical men towards it and of inducing them to make known, in their respective circles, those observations which may be likely to prove beneficial in mitigating evils, which must be so severely afflictive tajhe poor. " The particular enlargements of the ends of the bones here described, differ sufficiently from those which take place in scrophula, to allow the distinction to be very easily made: they occur much later in lite than the latter ; the tumours never acquire that magnitude, nor that soft and pulpy feel; nor does the skin possess that glossiness and redness which are observable in scrophulous tumours; neither do they, except very rarely, terminate in suppuration. They differ from those tumours of the joints which proceed from external injury* and which generally accompany a carious state of the bones, in the pain and tenderness, as well son's, who has leisure and genius to pursue it, and whose reports will be received with such confidence, as should encourage his perseverance and frequent communication. Fellow, of the Royal College of Physicians, and of the Royal Philosophical Society; and Senior Physician to the Royal Infirmary. Svo. pp. 320. Edinburgh, 1805. The reputation of Dr. Hamilton, as a practical physician, is too well known to require any comment here ; and it always gives us much satisfaction, when we fipd such men as these, offering the result of their observations to the public. From them "we expect certain aphorisms, which may be referred to by younger practitioners ; instead of fine spun theories, many of which vanish as soon as they appear.
Though the present performance does not claim any great pretensions to novelty, yet it abounds with valuable remarks; and, We must conclude, it is not without some necessity, that it issues from the source to which we owe it.
Probably in the North, greater prejudices against purgative medicines may prevail than in the South. But let us first take a view of the work, that our readers may be enabled to follow us in our remarks.
The first Chapter contains general observations on purgative medicines.
After some remarks on the changes to which the practice of physic must always be liable, the author continues : " I make these observations as an apology, if one is necessary, for my having occasionally deserted the usual track, which has been pointed out by men of consideration in practical medicine, I have deserted this track, more particularly in what relates to the administration of purgative medicines. I have been led to consider this subject minutely, from a habit of attending to the means of supporting, and, when necessary, of restoring the healthy action of the stomach, and intestinal canal; which action is of great importance, and which is liable to be disordered, and in this state, to produce much distress in various diseases. " In the course of the following observations, when I call in question the opinions of respectable authors, I trust I shall speak with that deference and caution, which I feel to be due to them ; being well aware how apt we are to take erroneous views in discissions that are purely theoretical.?And when I propose those Changes in practice, which experience has taught me to be useful, I will do so with a confidence proportionate to that experience ?upon which my opinions are founded. Nevertheless, I beg it to. be understood, that I respectfully submit the changes which I suggest, to the consideration of my professional Brethren ; and request, that, after a full trial, they will give a candid decision on their meritsj for the judgement of the public is the test, by which.
Dr. Hamilton's Observations on purgative Medicines. 133 which, I am sensible, they must ultimately be .confirmed or re? jectcd. " The importance of the functions nf the stomach and intestines is well known, and universally admitted. By means of these functions our food is digested and assimulated, and is carried, under the torm of a nutritious fluid, into the system. Besides, the power of sympathy connects the stomach and bowels with many other part" oi the complicated animal machine ; and strengthens the influence which these organs maintain over the comfort, the health, and the life of every individual. Hence it is obvious, that disorders of the stomach and bowels must greatly affect the system at large ; and that, in proportion to the degree and duration of these disorders, the affection of the general habit will be more or less serious and afflicting. , " There is certainly nothing new in the observation, that the constipated and loaded state of the intestinal canal, is a common cause, of general bad health. But when I go the length of saying, that this state generally accompanies and aggravates the other symptoms of fever ; that it is also the immediate cause of certain disorders peculiar to children and young people ; I am aware that'I advance opinions, in which there is a considerable degree of novelty ; but in which, 1 trust, the following sheets will satisfy the medical reader, that there is alse, at least, an equal degree of soundness." The subject is continued a few pages further, but nothing occurs of sufficient importance particularly to arrest our attention.
The next Chapter, is on the .utility of purgative medicines in typhus fever. The most useful observation in this, is, that ths .indiscriminate use of emetics in the beginning of these fevers, so generally adopted by the disciples of a once celebrated professor, is discouraged or shewn to be often unnecessary. Tha , author found great advantages from brisk purgative medicines in a fever which spread from the French prisoners, and also from the crew of a merchantman at Leith. In these, lie discovered, that his antimonial medicine was only efficacious when it proved purgative. This induced him to ensure that effect, with mora certainty, by a proper combination with other ingredients; and the event answered his expectation. Since that time, he has seen no reason to alter, but every thing to confirm his practice. These remarks conclude in the following words : " Accordingly, it is now some years since I have left off, almost entirely, the practice of ordering emetics and glysters in fever. I trust to a purgative, to ensure a regular alviue evacuation. For this purpose, however, a daily purgative is not always required. Thus, avoiding the harrassing distress, which generally accompanies the operation of an emetic given to patients in a state of fever ; as well as the trouble and fatigue, which the exhibition of "lvsters occasions; I think X conduct, the treatment N 4 184 Dr. Hamilton's Observations on purgative, Medicines. of typhus fever to a favourable issue, with more certainty, and with the greater ease and comfort of the patiest. " This practice, which I have found useful, 1 and which respects only the state of the intestinal canal, supersedes by no means, usual attention to the various other means of cure, employed in fever. I am even ready to allow, although I exclude emetics and glysters from my general practice in typhus, that peculi'ar circumstances may, occasionally, make both the one and other necessary.
" I Cannot, however, omit remarking, that for.some years past, I find wine less necessary in fever, than I formerly thought it was.
This may be owing to the fever which has prevailed of late being less malignant than it was some years ago ; or to the effect of the purgative medicines which I have employed, and which may obviate symptoms of debility, as well as remove them. " If this is a just view of the case, the plain inference is, that tfee employment of purgative medicines, to preserve a regular state of the belly, does not increase the debilitating effects of fever. This doctrine, I know, is contrary to the opinion generally received; but I am confident, that it is consonant to the fact. " The object to be attained, is the complete and regular evacuation of the offensive feculent matter collected in the bowels, in the course of fever. Within this limit, the practice is safe and salutary. Of this I am assured, that I have had much satisfaction in the prosecution of it; and have not in a single instance, had occasion to regret any injury or bad consequence proceeding from it. For I am not an advocate for its being carried to the length of exciting unusual secretion in the cavity of the intestines, or of procuring copious watery stools. Such indeed, while they are not requisite, might increase the debility so much and so justly dreaded.
" In further recommendation of the practice, I observe that it is conducted with case, and a tolerable degree of certainty. The precise effect of purgative medicines, may not, in every instance, be altogether under command; but in general it is so, if, to a little experience, Ave join a previous knowledge of the peculiarities in particular constitutions. At any rate, the subsequent doses of purgative medicines, and the repetition of them, will be regulated by the effect of preceding ones. " It is of importance, to consult in all respects the quiet and comfort of patients, in fever. On this account, the exhibition of purgative medicines should be so timed, that their effects may be expected during the day, when proper assistance can bn best procured to the patient. " The purgative medicines which I have chiefly employed in fever, are calomel, calomel and jalap, compound powder of jalap, aloes, solutions of any mild neutral salt, infusion of senna, and sometimes the two last mentioned medicines conjoined." Thet Dr. Hamilton's Observations on purgative, Medicines. 185 The second Chapter is on the utility of purgatives in scarlatina. The author is disposed to consider cynanche maligna as the same disease, and advises a similar exhibition of purgative medicines in each. As, however, his principal design is rather to relieve the intestines from any injurious accumulation, than to lessen the strength of the patient, we apprehend, few of our readers will be disposed to differ with him.
Nor is it likely many objections should be made against the exhibition of purgative medicines in that species of " marasmus, which appears in childhood and early youth." The advantage ol full doses of calomel are now generally admitted. We shall -therefore content ourselves with transcribing a single passage, which, though not altogether new, contains a caution, that cannot be too often impressed on practitioners of every age and rank in the profession. " While," says the author, " I thus give appropriate purgative medicines, I find it necessary, in order to have full information of their effects, to inspect daily what is passed at stool. The smell and appearance of the fasces are a criterion of the progress we make in the cure, and direct the farther administration of the purgatives. This inspection is the more necessary, as we cannot expect the information we want from our little patients; and we will often look for it in vain from the attendants, whose prejudices, and whose ignorance of our views, prevent their seeing the propriety of the enquiry.

"
During the prevalence of the disease, the fseces are dark, fetid, and varying from a costive consistence to that of clay, and are often fluid ; and such they appear upon the first exhibition of the purgative medicines. I observe that the recovery of the sick keeps pace with the return of faeces of natural colour, form, and smell ; a change which the repetition of purgatives does not fail to produce." Some useful remarks are added on the indolence of many practitioners in imputing so many of the complaints in children to worms.
Though this error is gradually losing ground, we trust, the remarks made b}7 this judicious writer will not be without their use.
Dr. Hamilton is of opinion, that marasmus either precedes or accompanies hydrocephalus, epilepsy, and other formidable diseases. This is certainly true, and we doubt not, that he has often been successful in relieving them by strong purges. We can say the same of our own practice ; but in these cases, we have directed our views to relieve a kind of chronic or habitual plethora, rather than the removal of accumulated faeces. This suggestion is not intended to lessen the value of our author's re-\inark, which, we doubt not, is founded on close observation. ease, yet bis practice was perfectly conformable to what is here proposed. It is much to be regretted, that the erroneous theories of that invaluable author, have in su many instances entailed upon \is a practicc contrary to his own, and for which we have, in many instances, invented theories little better than his. The cases given by our author, prove the justice of his opinions beyond any question, but we cannot admit it as a necessary inference, nor do we conceive it will be expected, that chorea never arises from any Other causes than those here assigned.
The following Chapter 011 chlorosis is particularly deserving notice. This disease, though more common in the North, and among young females who arc ill fed and too sedentary, is, however, known in all climates, and in every rank of life. It has been too common to impute it, altogether, to amenorrhea, and consider chalybeates as the only remedy. It must be confessed, that however general the success of these remedies may have proved, they have often failed ; and we are under many obligations to Dr, Hamilton for pointing out other causes.
The sixth Chapter is on the utility of purgative medicines in one species of hffiinatemesis or vomitting of blood, which the author describes in the following words. " There is, says he, one variety of hsematemesis which attacks females who are from eighteen to thirty years of age ; and it rarely appears sooner or later than these periods, which I shall endeavour to illustrate. " As 1 confine my attention to this variety, the observations which I am about to make, will not apply to hrematemesis, which originates in organic affection of the stomach, and viscera c?nnectcd with it, either as a constitutional disease, or the consequence of previous irregularities and intemperance. I have seen several instances of this vomiting of blood, the cure of which is doubtful in the extreme and difficult. " The attack of the luernorrhagy, of which I am to speak, is preceded by great languor and oppression, both about the chest, and the praecordia; and by a sense of fulness of the prajcordia, by cough, dyspnoea, and sometimes by pain of breast; by loss of appetite, head-ach, vertigo, and disturbed sleep. The eye is dull, the countenance is expressive of much distress, the pulse is feeble, and the bowels are constipated.

"
In this state of impaired health, a particular fit of sickness and nausea is the immediate fore-runner of the attack of the vomiting of blood. The blood vomited is sometimes florid, and, at other times, black and grumous. The quantity of blood brought up at one time, varies from a few ounces, to the quantity of a pound or more. The distressing symptoms are relieved by this discharge of blood; but are again aggravated, previously to the return of a similar attack. tions which it was in my power to bring forward ; they have been partially noticed in one periodical publication and made the subject of hasty and mistaken criticism in another/' What fether publication may have noticed this practice, we know not; but for ourselves, we trust Dr. Hamilton will not accuse us of any partial notice of ins " peculiarities of practice." The cases we met with were described by one of the young gentlemen he speaks of, and in a manner much too superficial to enable us to form those important decisions which the work before us induce. If, however, the partial notice in another publication, and the mistaken, we will not admit hasty, criticism in our own, have been the cause of the present production, we shall readily bear our share of the blame, and hope that the reception of his first labours will prove a sufficient encouragement for the author to enlarge them hereafter. il The object of this publication," we are informed, "is to give a compressed clinical account of a Remittent Fever, which the author has had repeated opportunities of investigating, while he was employed as Physician to the Forces; and he flatters himself, that he has been enabled to give some useful information on the nature of a disease, of frequent occurrence, among the military in this climate, during the cold months of the year." Having premised thus much, Dr. S. next gives his reasons for suspecting the disease to be contagious: " It has seldom happened, that officers belonging to regiments, in which this disease has occurred, have been infected; though the medical attendants of the sick, and servants attached to the regimental hospitals, have very rarely wholly escaped, and, in some instances, the whole of them have taken the disease. " While patients, labouring under this fever, were in Deal General Military Hospital, (though not over crouded) where ventilation, fumigation, and cleanliness were much attended to, the medical mates and hospital servants, very rarely, remained long uninfected.
. " The disease prevails to no considerable extent, except among men in barracks, and in confined and crouded situations. " It has been observed to attack great numbers of one regiment, while another, under the same external circumstances, and within the same barrack wall, has remained, for some time, free from it. " These circumstances prove, that the causc of the disease acts in it very confined sphere, and totally fexclude the idea, that it is produced wholly by the qualities of the air, by the season, or any common surrounding source of unhealthiness; but the inductive proofs seem strongly to imply that its exciting cause is contagion." We have copied thus much from the work, because we could not compress the author's meaning in fewer words. We might say the same of the " History of the Disease" which follows, and which we have perused with much pleasure several times over. Most of the. symptoms might, by a less judicious observer, be mistaken for typhus ; hence the necessity of the most accurate discrimination, since the mode of treatment, recommended perhaps too indiscriminately in typhus, is found highly injurious in this fever. With symptoms of the most extreme debility, are always associated either violent visceral inflammation, or great local congestion in some important organs. This might have been doubted, had not frequent dissections proved the fact beyond all question.
The period of the disease varies according to its violence. Death frequently occurs in the first week, and sometimes as early as the third day. In these cases the patient shows great anxiety, oppression of the breast, and laborious respiration. These symptoms rapidly increase with a pulse fluttering and sinking, or throbbing, till ihe last moment, which, under such circumstances, is seldom delayed longer than from six to twelve hours. The most favorable prognostic seems to have been formed when the pains, though violent, were shifting, and often in the extremities, and also when the disease assumed an intermittent form ; but when relief follows the occurrence of dysenteric symptoms, the issue was generally fatal. Before entering into a detail of the cure, Dr. Sutton premises the following remarks: " In one instance of the occurrence of this disease, when treated as typhus, out of thirty-seven patients received into the hospital, eleven died.
nents, or mere calumniators, Mr. R. contents himself with simple refutation, and dismisses them as concisely as possible; but Dr. M. is honoured with a pamphlet of 2^0 pages, in which his wit is answered by wit, his arguments by arguments, and even his uncandid statements are treated with considerable respect. In fact, Mr. R.
appears to have availed himself of the rank Dr. M. holds in the profession, and the important public situation he fills, to give, thro' him, a general and full answer to all the alleged failures, consequent diseases, eruptions, &c. which have been so often, so industriously, and so unfairly (to say the least) dragged into public notice.
In our opinion Mr. R. has not failed in any part of his object; but, it has been oljserved in all ages that truth, philanthropy, and scicnce cannot oppose falsehood, self interest and ignorance, on equal terms. The number of readers and their motives are most disproportionate. Those who read Dr. M's attack with pleasure, will not read Mr. R's answer with candour; this, however, is the lot of humanity, aiid arises from causes that will never cease to operate.
We have no doubt that all the friends of vaccination will cordially thank their indefatigable friend and champion; and if they read this Answer with the same pleasure that it has afforded us, they will confess that superior gratifications arising from controversy, so conducted, are rare indeed. To us, Mr. R's answer appears to be as complete a refutation of all the reasoning, as satisfactory a reply to all the alleged cases, and as brilliant a retort of all the wit, as such an attack can require.
Mr. R. has divided his answer into several parts or sections; the first, to page 1.0, contains general observations on the style, manner, and spirit of Dr. M's attack. In the next, he examines the first part of Dr. M's Treatise at considerable length, and proves that the inoculation of the small-pox, on its first introduction into England, met with infinitely more opposition than vaccination has encountered. That this opposition was far more general and inveterate than the present, and supported by characters of much importance in society.
Our author then adverts to the London testimonial in favour of vaccination, to the number and respectability of the signatures, and contrasts them with the opponents of the practice. This leads him to the evidence given before the Committee of the House of Commons. The enemies of Dr. Jenner's discovery never appear to recollect, that the greatest care was taken by him that all his acknowledged opponents should be personally examined by the Committee, and all unfavourable reports, however frivolous, properly investigated. After this inquisition, examination, and investigation, the House of Commons came to the resolution which planted such rankling thorns in the breasts of Dr. Jenner's enemies. This deci-sion^ together with the rapid establishment of the Royal Jcnnerian Society, Society, silenced as far as possible, all avowed opposition to the practicc for a considerable time. It was not however in England alone that the importance of vaccination was duly appreciated, fo? an institution similar to the Royal Jennerian Society was established in Paris, and a regular correspondence with the other departments of the empire provided for. Mr. II, has given the plan of this institution, and subjoined an account of the progress of vaccination in Germany and other parts of the Continent. After some criticisms on other publications, our author gives an account ot yarious instances in which the small-pox occurred a second time, as well after the natural as the inoculated disease; instances of the latter kind are, indeed, far from uncommon. As the cases in Full wood's Rents produced a stronger sensation in the public mind, on account of the great number of practitioners who witnessed them, and the candid investigation of them by the Committee, than any other imputed failures; so Mr. R. has been more minute and circumstantial in his examination of the weight they ought to have with the public. In this, however, as well as other parts of his Answer, a number of collateral topics are frequently introduced, which, though connected with the subject, sometimes distract the attention, and always diminish the weight of the principal argument; but as the attack was desultory, so is the answer.
The question at issue is of the first importance, and consequently it required a full and extensive discussion to establish the truth, and expose misrepresentation; but this very copiousness is in danger of injuring the cause it ought to serve, for many will read a short pamphlet, that abounds with assertion, invective, abuse, calumny or misrepresentation, on a popular subject, while very few will have perseverance enough to weigh and compare the reasoning of a voluminous answer.
In this respect, as we have already said, truth, philanthropy and candour are very unequally opposed to falsehood, bigotry and misrepresentation; and on this account we think the size of Mr. Ring's book will considerably diminish the good it is otherwise so well calculated to produce.